New York Catholic bishops issue new guidebook on making end-of-life decisions
New York Catholic bishops released an updated guidebook, "Now and at the Hour of Our Death", outlining Church teaching on assisted suicide and end‑of‑life decisions. The booklet explains moral principles, distinguishes obligatory from optional care, and lists advance‑care planning options available in New York. It urges Catholics to appoint informed proxies to make medical decisions if they become unable to do so. The guide responds to New York’s recent law legalizing assisted suicide and addresses broader end‑of‑life questions. The publication serves as a practical resource for Catholics navigating complex medical choices.
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The New York Catholic bishops have released an updated pamphlet, “Now and at the Hour of Our Death,” to help Catholics navigate end‑of‑life choices in light of the state’s new assisted‑suicide law. The guide explains Church teaching on assisted suicide, distinguishes between “ordinary” (morally required) and “extraordinary” (morally optional) medical interventions, and urges prayerful, collaborative decision‑making with the aid of proxies and spiritual advisers 1.
The booklet is intended to “simply explain the moral principles of Catholic teaching with regard to end‑of‑life decision‑making and to outline the options that exist in New York state for advance care planning” 1. It stresses that Catholics should appoint informed health‑care proxies and consider the virtues of prudence when weighing treatment options.
Assisted suicide is defined as the voluntary termination of one’s own life using physician‑prescribed drugs and is labeled “active euthanasia.” The bishops state unequivocally that the practice is “objectively immoral and must be avoided” 1. They also condemn “passive euthanasia” – withholding ordinary care with the intention of causing death – as gravely contrary to God’s will.
The guide notes that removing life‑sustaining measures solely because a patient’s life is deemed “no longer valuable” is impermissible, though exceptions may exist when death is imminent or the intervention causes severe side effects.
The bishops advise that decisions should be made “collaboratively with the patient or surrogate, family members, health‑care providers, and spiritual adviser” 1. Prayer is emphasized as essential, and the health‑care proxy is recommended as the most appropriate advance‑care tool in New York. The New York State Catholic Conference provides a state‑approved proxy form for Catholics to designate trusted surrogates.
Dennis Poust, executive director of the New York State Catholic Conference, highlighted that the original guide has been used for over 15 years and hopes the updated version will reach “many thousands more Catholics” facing health crises 1. The bishops encourage all faithful to read the booklet and become familiar with Church teaching before a crisis occurs.
Investigate Catholic doctrine on assisted suicide and advance directives
Catholic doctrine makes a clear moral distinction between (1) assisted suicide/euthanasia (directly willing or causing death) and (2) legitimate end-of-life decisions (refusing “overly burdensome” treatment and providing comfort care). It also teaches how advance directives should be understood and implemented: they must be conformed to Catholic moral teaching, not treated as authorization for killing.
The Church teaches that euthanasia is intrinsically evil in every circumstance and that assisted suicide likewise cannot be justified as “respectable” autonomy.
Assisted suicide is morally akin to cooperating in (or even becoming an “actual perpetrator of”) an injustice:
“To concur with the intention of another person to commit suicide and to help in carrying it out through so-called ‘assisted suicide’ means to cooperate in, and at times to be the actual perpetrator of, an injustice which can never be excused, even if it is requested.”
In Evangelium Vitae, the Church states:
“Suicide is always as morally objectionable as murder… To concur with the intention of another person to commit suicide and to help in carrying it out…”
Caring for persons in critical and terminal phases reiterates that health care workers must remain “always at the service of life,” and that there is no right enabling a provider to be compelled to execute what Catholic teaching calls a “non-existent right.”
Evangelium Vitae explicitly critiques the idea that euthanasia/assisted suicide is compassion:
“Even when not motivated by a selfish refusal to be burdened… euthanasia must be called a false mercy… ‘True “compassion” leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear.’”
A central Catholic principle is proportionate vs. disproportionate means of medical care.
The 1980 Declaration on Euthanasia explains that the moral tradition distinguishes the duty to use necessary means from the option to refuse means that would be excessively burdensome or would only prolong dying in an unhelpful way.
It stresses “proportionate” and “disproportionate” means (rather than relying only on whether a method is “extraordinary”):
“…it is permitted… to have recourse to… advanced medical techniques…” if no sufficient remedies exist; it is also permitted to interrupt them if results fall short—while also permitting refusal of techniques that are “already in use but which carries a risk or is burdensome.”
It also states a key boundary: when death is imminent, it may be permitted to refuse treatments that would only secure a “precarious and burdensome prolongation of life,” provided normal care for the sick person is not interrupted.
The USCCB’s Ethical and Religious Directives apply these principles to Catholic health care settings:
Forgo disproportionate means:
“A person may forgo extraordinary or disproportionate means of preserving life.”
(With “disproportionate” meaning, in the patient’s judgment, no reasonable hope of benefit or an excessive burden/expense.)
Competent adult decisions:
“should always be respected and normally complied with, unless it is contrary to Catholic moral teaching.”
So the Church can say “advance directive honored” and still reject killing: the directive is not treated as binding if it conflicts with Catholic moral truth.
Catholic teaching allows interventions intended for relief of pain even when they may indirectly shorten life—as long as the intent is not to hasten death.
The USCCB states:
“Medicines capable of alleviating or suppressing pain may be given… even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death.”
Pope John Paul II likewise highlights the priority of care including pain relief and support, warning against approaches that shift into terminating life:
“What is needed today… is the care which includes effective and accessible forms of treatment, relief of pain, and the ordinary means of support.”
In Catholic institutional health care, the USCCB states:
“The institution… will not honor an advance directive that is contrary to Catholic teaching.”
If an advance directive conflicts with Catholic moral teaching, the patient should receive an explanation why it cannot be followed.
Catholic health care must ensure the patient (or surrogate) can form conscience through access to medical and moral information and counseling:
“Each person or the person’s surrogate should have access to medical and moral information and counseling so as to be able to form his or her conscience.”
Then:
“The free and informed health care decision… is to be followed so long as it does not contradict Catholic principles.”
The USCCB also addresses how advance directives often work through a named decision-maker (surrogate). It states:
“Each person may identify in advance a representative… Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person’s intentions and values…”
The CDF’s Samaritanus bonus discusses how end-of-life protocols—initially intended to avoid aggressive treatment—can become problematic if treated in a euthanistic framework.
The CDF notes that protocols such as Do Not Resuscitate orders and Physician Orders for Life Sustaining Treatment (POLST) were “initially thought of” to avoid aggressive treatment in terminal phases, but:
“Today these protocols cause serious problems regarding the duty to protect the life of patients in the most critical stages of sickness.”
It describes a worrying pattern in some settings:
“concerns have recently arisen about the widely reported abuse of such protocols viewed in a euthanistic perspective… with the result that neither patients nor families are consulted in final decisions about care.”
This warning is important for Catholics because it shows that even documents/medical orders that sound neutral may be interpreted in ways that drift from “non-proportionate treatment” toward “euthanistic intent.”
Based on the sources above, a Catholic advance directive can coherently aim at decisions like these:
Catholic doctrine rejects assisted suicide and euthanasia as intrinsically wrong acts—no request can transform them into something morally permitted. At the same time, it permits decisions that may withhold or withdraw disproportionate treatment and it strongly supports palliative care and pain relief, provided the intent is not to hasten death and ordinary care is not interrupted.
For advance directives, Catholic teaching (as expressed in authoritative Catholic ethical directives) requires that Catholic institutions will not honor directives contrary to Catholic moral teaching, and that surrogates and clinicians act within the limits of Catholic principles.